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Overweight kindergartners more likely to become obese by eighth grade
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The incidence of obesity among children aged 5 to 14 years in the United States was four times higher among children who had been overweight at age 5 years compared with children of normal weight at the same age, according to findings published in The New England Journal of Medicine.
“We uncovered several important points by examining incidence. First, a component of the course to obesity is already established by the age of 5 years,” Solveig A. Cunningham, PhD, of the Hubert Department of Global Health at Emory University, and colleagues wrote. “Second, obesity incidence among overweight children tended to occur early in elementary school.”
Data were evaluated from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 in the United States. Of the 7,738 patients examined, 6,807 were not considered to be obese at baseline and were followed for 50,396 person-years.
Upon entrance into kindergarten, 12.4% of the children (mean age, 5.6 years) were obese and 14.9% were overweight. By eighth grade (mean age, 14.1 years), 20.8% were obese and 17% were overweight, according to data.
Cunningham and colleagues observed a decrease in the annual incidence of obesity from 5.4% during kindergarten to 1.7% between fifth and eighth grade, they wrote.
Nine-year cumulative incidence data indicated overweight children aged 5 years were four times more likely to become obese (31.8%) compared with normal-weight children (7.9%).
Approximately half of those who became obese at age 5 to 14 years were overweight at baseline, and 75% had been above the 70th percentile for BMI at baseline, according to data.
In an accompanying editorial, Steven L. Gortmaker, PhD, of the Harvard School of Public Health, and Elsie M. Taveras, MD, MPH, of Massachusetts General Hospital, wrote that the study adds to evidence established within the literature.
“The implication for practice is that early excess weight gain is a risk factor for obesity in later childhood across the entire population,” they wrote.
They suggest improved nutrition and physical activity in this patient population to reduce early childhood weight gain and the risk for incident obesity.
For more information:
Cunningham SA. N Engl J Med. 2014;370:403-411.
Gortmaker SL. N Engl J Med. 2014;370:475-476.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Ruth Loos, PhD
While previous studies have shown repeatedly that more than one third of adult Americans are obese, Cunningham and colleagues aimed to determine at what age people are most vulnerable of becoming obese. By following more than 7,000 children from kindergarten until eighth grade, they showed that obesity is established early on in life, before 8 years. Children who were overweight at age 5 were four times more likely to be obese in eighth grade, compared to 5-year-olds of normal-weight of whom very few became obese during the subsequent 9 years of follow-up. Furthermore, very few overweight 5-year-olds became normal-weight by eighth grade.
One’s susceptibility to obesity is the result of a complex interplay between genes, lifestyle and intrauterine influences. This new study shows that this susceptibility comes to expression at a young age and tracks through adolescence into adulthood. Therefore, obesity prevention should target young children through their parents and their environment.
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